1

Evidence into Practice Supporting partners to quit smoking

1

Introduction

This briefing should support the delivery of interventions to reduce smoking prevalence among pregnant

women's partners or other household members. It reviews the evidence base for interventions targeting

partners and includes case studies from programmes currently underway in England.

The briefing sets out:

» Impact of smoking and exposure to secondhand smoke during pregnancy

» Addressing partners' smoking: National guidance

» What interventions to support partners and other household members to quit look like

» Current evidence base for supporting partners to quit: before, during and after pregnancy

» Creating smokefree homes

» Conclusions

1. Impact of smoking and exposure to secondhand smoke during

pregnancy

Smoking and exposure to secondhand smoke (SHS) during pregnancy increases the risk of stillbirth,

miscarriage, preterm birth, heart defects, low birth weight and sudden infant death (SIDS).

Source: Smoking in Pregnancy Challenge Group. Review of the Challenge 2018. July 2018.1

The focus of most work to reduce rates of smoking in pregnancy has been on the women who smoke, not on

the environments in which they live. For many women struggling to quit throughout pregnancy the home

environment will play a crucial role in whether they are smoking at conception, if they are able to successfully

quit, whether they relapse to smoking once the baby is born and if they and the baby are exposed to SHS.1

Women who live with a smoker are 6 times more likely to smoke throughout pregnancy and those who live

with a smoker and manage to quit are more likely to relapse to smoking once the baby is born. An estimated

20% of women are also exposed to SHS in the home throughout their pregnancy, leading to an increased

risk of many of the same adverse birth outcomes experienced by women who smoke.1

There is, therefore, an opportunity for services to intervene to support families and communities to become

smokefree as part of addressing rates of smoking in pregnancy. Reaching into households and communities

requires a new way of working with different kinds of professionals. There are many professionals who have

regular contact with families and prospective parents who could play an important role in highlighting the

need to quit smoking, the benefits to children and signpost mothers, fathers and other household members

to cessation support. Such groups include maternity professionals such as midwives, health visitors, and

paediatricians but also professionals in children’ services, social housing providers, family planning and

sexual health services, and mental health service providers.1 Services also need to consider other, potentially

more effective ways to engage fathers before, during and after pregnancy. This means trialling different types

of health messaging that focuses on fathering and men’s experiences and considering the role that online

stop smoking and health promotion programmes can play in reaching men who are less likely to access other

services.

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2. Addressing partners' smoking: National guidance

NICE guidance PH26 ‘Smoking: stopping in pregnancy and after childbirth’ and the NCSCT ‘Briefing for

maternity care providers’ and ‘Standard Treatment Programme for Pregnant Women’ recommend a tailored

approach to treating smoking among partners and other household members. 2 3 4

In line with this guidance, all pregnant women should be asked whether their partner smokes or if there are

other smokers in their home. Exhaled breath carbon monoxide (CO) monitoring – which should take place at

the booking and 36-week antenatal appointments and as appropriate throughout pregnancy – can help to

identify if a pregnant woman has been exposed to SHS and can provide a route into conversations about

household smoking. If the woman does live with a smoker, it is important that she understands that:

» Exposure to SHS significantly reduces the chances of a healthy pregnancy.

» Living with a smoker or being around smokers will make it harder to quit and stay smokefree.3

» Introducing a smokefree home can increase the likelihood that their partner/household member will

be able to quit smoking successfully.5 6

Partners who smoke should be given clear advice about the harms of SHS to the pregnant woman and the

baby, and informed that they should not smoke around the pregnant woman or baby, especially in the home

or car. They should be offered a tailored intervention comprising of three or more elements (very brief advice,

behavioural support and pharmacotherapy) and multiple contacts. The intervention should consider partners’

preferences, the likelihood that they will follow the course of treatment, and their previous experience of stop

smoking aids to ensure they are recommended the approach most likely to help them quit.2

Additionally, the NHS Long Term Plan commits to offering NHS-funded tobacco treatment services to the

partners of pregnant women who smoke, as part of an adapted smokefree pregnancy pathway.7

3. What interventions to support partners and other household members to

quit look like

Interventions to reduce smoking among partners and other household members typically have three key

outcomes:

» To protect pregnant women and children from SHS exposure by creating and maintaining a smokefree

home.

» To support partners and other household members who smoke to quit, or if they are unable to quit,

moderate their smoking behaviour by smoking outside the home and away from pregnant women and

children.

» To support pregnant women who have quit or are trying to quit to have a smokefree home.

Although approaches which are effective for increasing quitting among adults in general are likely to be

effective for treating smoking partners, there is currently no standardised approach for engaging partners

with stop smoking interventions. Some interventions aimed at partners are delivered solely to the partner

while others are delivered to both the partner and the pregnant woman. The methods and outcome measures

are highly variable from one scheme to another and are heavily determined by the cultural context of the

target population. 8 9 General features of these interventions include:

» Educational interventions, typically based in health care settings (e.g. antenatal appointment), using

direct teaching or counselling, brochures, posters, role-play and/or videos;

» Tailored approaches targeting high prevalence population groups;

» Pharmacological and behavioural support offered to fathers and other household members. This

support should address the specific barriers and facilitators for quitting among fathers;

» Clear messaging around the harms of SHS exposure and the importance of maintaining a smokefree

home. This should include advice about what works (not allowing smoking inside) and what doesn’t

(opening windows).

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4. Preconception

Rates of smoking have a strong social and age gradient with poorer and younger women much more likely

to be smokers. As women get older, they are more likely to give up smoking before getting pregnant.10 Rates

of smoking for young (18-34) white women in routine and manual occupations are currently more than double

(27.7%) that of women on average (12.5%).11 This inequality for all women is reflected in pregnant women.12

While some women give up smoking because of pregnancy, the data suggests that for others, particularly

younger women, smoking can become entrenched during pregnancy.10

Rates of smoking among young men are similarly skewed, with 31.2% of young (18-34) white men in routine

and manual occupations smoking, compared to 16.4% of men overall.11 Consequently, women living with

these men are more likely to be exposed to SHS and less likely to have a home environment that is facilitating

quitting.

4.1 Reaching young men

Reaching these groups may require a targeted, innovative approach and working with different professionals

across a broader range of settings. There is some evidence to suggest that preconception health information

provided by GPs or health professionals or from other sources (including online) has the potential to increase

positive pre-pregnancy health behaviour in men.13 Family planning and fertility services could train staff to

identify smokers and deliver very brief advice (VBA) as well as specific messaging around the harms of SHS,

and offer referral to stop smoking services.14

However, it is recognised that men have less direct contact with family planning services and are less likely

to access healthcare in general.13 This is likely to be particularly salient for men working in routine and manual

occupations who are less likely to be able to take time off work to attend appointments. Digital health

interventions targeted at men may be effective for reaching partners from more deprived socio-economic

groups, although further research is needed.13

Localities need to consider whether there are there particular workplaces employing lots of young men locally

and whether this group is accessing other services (e.g. mental health). Partnering with social housing

providers is also likely to be an effective way of reaching this cohort. Smoking rates among people living in

social housing are more than double the national average at approximately 35%15 so improving reach into

these communities is likely to be an effective way to reach young smokers. Localities must consider which

professional groups are best placed to deliver these messages and what types of intervention are likely to be

most effective. Other settings relevant to this population include primary care services and sexual health

services, or education settings like further education and vocational colleges.

4.2. Ensuring consistent service provision

ASH’s annual tobacco control reports detail the variation in stop smoking services available in different

areas.16 In 2019, all areas responding to the survey commissioned stop smoking support for pregnant women,

however this support is not necessarily available to women or their partners pre-conception. Local Maternity

System’s (LMS) should engage with local authority public health teams and stop smoking services to identify

the service offer available to women and their partners before pregnancy and ensure that other healthcare

providers are delivering consistent, evidence-based messages around the importance of quitting smoking.

Reducing prevalence among all men and women in this age group through population-level and targeted

interventions will be crucial to achieving specific reductions in smoking during pregnancy and pregnant

women’s exposure to SHS.

Useful resources

» Smoking in Pregnancy Challenge Group. LMS Smokefree Pregnancy Pathway. 2020.

» Planning a pregnancy resources developed by Tommy’s for women and families.

» Public Health England. Preconception care: making the case. 2019.

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5. Intervening during pregnancy

An estimated 20% of women are exposed to SHS in the home throughout their pregnancy, leading to an

increased risk of many of the same adverse birth outcomes experienced by women who smoke. Interventions

to reduce both smoking and non-smoking pregnant women’s exposure to SHS during pregnancy need to be

further developed.

5.1 Targeting interventions at pregnant women

There is limited evidence around the effectiveness of smokefree home interventions which target fathers,

because most existing research focuses on women’s experiences of smoking behaviour change in these

settings. 8 9 These interventions tend to lay the responsibility for SHS avoidance/reduction on the pregnant

woman, rather than focussing on the role of other smoking household members to prevent exposure to the

pregnant woman.

In a systematic review of nine interventions which aimed to reduce pregnant women’s exposure to SHS,

seven targeted the intervention solely at the pregnant women. 8 This was done primarily through education

materials, counselling or guidance around the health effects of SHS and how best to avoid SHS exposure in

the home or workplace.

However, evidence has shown that encouraging pregnant women to provide counselling and encouragement

to their partners to help them quit does not increase quit rates. 8 17 Interventions which put the onus on the

woman to change the smoking behaviour of their partners are particularly problematic in households with

gender power imbalances.9 There is consequently a need for approaches which directly encourages partners

to quit smoking and engage with all members of smoking households to create a smokefree home.

5.2 Whole-family approaches

Approaches which involve partners and the wider household are likely to be more effective for reducing SHS

exposure among pregnant women and children, although further research is needed.

An intervention involving 60 smoking men, based on providing education on the effects of SHS, reduced

exposure among their non-smoking pregnant wives.18 The men in the intervention group received a 30-45

minute face-to-face education session based on the health belief model (HBM), which used photos to

emphasise the impact SHS exposure during pregnancy has on the foetus. The HBM is based on the

understanding that a person will take a health-related action if they feel greater susceptibility to the risk of

experiencing negative health outcomes. Messages with educational tips were sent to the participants for the

following 6 weeks. 18

Participants were surveyed on their health beliefs shortly before and after the education session, and then

again 6 weeks later. The researchers found that women in the intervention group reported significantly lower

SHS exposure (mean number of cigarettes per week they were exposed to) 6 weeks following the intervention

(35.63 compared to 12.87). However, the total number of cigarettes smoked weekly (self-report) by men was

not significantly different. Although maintaining the health of the pregnancy was not sufficient motivation for

men to quit smoking, it was effective for creating smokefree homes by encouraging men to smoke away from

their pregnant wives. 18

Research suggests that encouraging women to change the behaviour of their partners is not effective. 8 9

Providing men with education on the impact of their smoking behaviour appears to have some impact, at

least in the short term, but there is a need for further research. Future work should examine the potential

effectiveness of NRT provision (both for creating a smokefree home and for cessation purposes) and/or

financial incentives for partners in helping to reduce the exposure of pregnant women (both smokers and

non-smokers) to SHS. 8 19 The case studies below highlight that interventions which involve partners/family

members can be an effective way to engage pregnant smokers and increase quit rates, particularly when

combined with financial incentives and NRT provision.

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Case study 1: Supporting a Smokefree Pregnancy (SaSFPS) in Greater Manchester (GM): The

influence of Significant Other Support

Strategic aim

The GM SaSFPS includes an option for the pregnant woman to recruit ‘Significant Other Support’ (SOS). The inspiration to include SOS within the GM SaSFPS was initially based on research showing that the combination of reinforced social support and financial incentives significantly increased the likelihood of a higher-than-usual quit rate among high risk pregnant women. 20 Analysis of a previous scheme in the North West (Supporting a Smokefree Pregnancy Scheme, 2010 – 2013) found that the odds of achieving a four-week quit was increased by 55% when participants received support from a significant other, compared to those did not.21

Design

The significant others (SO) within the GM scheme receive £60 worth of high street vouchers if the woman they are supporting remains smokefree up to 12 weeks postpartum. If the woman relapses when on the scheme the SO receives no vouchers. The SO can be anyone the woman nominates so long as they are 16yrs or over and are CO validated as smokefree*. The SO can be someone who is also quitting and does so along with the pregnant woman. They are expected to be CO validated:

» at time of quit commencement;

» at the end of the 4-week quit period;

» and there on every 4 weeks up until 12 weeks postpartum.

If the SO relapses they are no longer eligible for the vouchers, but the pregnant woman can remain on the scheme as long as she is still smokefree. The SO is required to sign a contract agreeing to the terms and conditions of the scheme.

* Scores less than 4ppm (parts per million) on a CO breath test

Outcomes

The initial outcomes are generated from participants on the original GM SaSFPS over a period of 18 months (Feb 2018 – July 2019).

54% (386/710) of the women recruited onto the scheme identified an SO. Women with SOS were almost twice as likely to achieve a 4-week quit than those without. This trend continued through to delivery and 12 weeks postpartum, although the overall numbers of women who maintained their quit decreased throughout pregnancy and postpartum.

Fig 1. Percentage of women who are quit at 4 weeks, 36 week’s gestation and 12 weeks postpartum with and without SOS support

62%

64%

65%

38%

36%

35%

4-week quit

Still quit at delivery

12 weeks post-partum

Without SOS With SOS

6

Case study 2: Poole Hospital NHS Foundation Trust and Public Health Dorset: Improving

Patient Care in a Tobacco Dependency Programme (IPCTD) A Quality Improvement Pilot for

Smoking Cessation Support to Family Members Wishing to Quit Smoking to Improve the Quit

Environment of the Smoking Pregnant Woman

Strategic aim

The key aim of the pilot was to contribute to a reduction in the prevalence of smoking in pregnancy to 6% or less by the end of 2022. This will be achieved by:

» Increasing engagement of pregnant smokers from 52% to 75% and maintain or improve the current

quit rate of 75%;

» Increasing the partner engagement rate from 4% to 30% and increasing the quit rate from 2.2% to

30%;

» Improving health outcomes for the 20-45 target age group who smoke and are less likely to access

health care;

» Reinforcing the simple prevention strategy that prevention is better than cure.

Design

This project is led by the Smoking in Pregnancy Midwifery services at Poole Hospital Foundation Trust. Specialist smoking in pregnancy liaison midwives provide pharmacotherapy and combined behavioural counselling sessions to the pregnant smoker and smoking partners/family members for the duration of the 12-week programme. This happens through a variety of contact methods including home visits and clinics to ensure good engagement.

The pregnant smoker, partner other household family members who smoke are seen “in tandem” to gain additional support from each other during the program. Both pregnant smokers and their smoking partners/family members are offered direct pharmacotherapy, avoiding the need for two separate pathways to be offered. Participants are CO monitored throughout the scheme to validate the quit and provide additional motivation.

Initial outcomes

1. Engagement of pregnant smokers setting a quit date has remained static at 52% (pilot target 75%)

but quit rates of those engaged has increased from 75% to 82%;

2. Partner engagement rate has increased from 4% to 39% (pilot target 30%);

3. Partner quit rates have increased from 2.2% to 60% (target 30%) and interestingly 90% opted for

Varenicline as their first choice of pharmacotherapy;

4. Two thirds of the partners engaged are from the targeted 20-45 age group.

5.3 Lessons for practice

» Interventions which are delivered at the household level can be effective for engaging smoking

partners, as they frame smoking as a household responsibility, with family-wide impact.

» Significant others need to be involved not just as providers of social support but as participants with

a stake in the change process.22

» Using financial incentives to recruit partners/significant others to support the pregnant woman’s quit

attempt can be an effective way to increase quit rates.

» Providing behavioural support and pharmacotherapy jointly to pregnant smokers and their smoking

partners/family members can increase quit rates among pregnant women and partners and could be

beneficial for creating a smokefree home.

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6. Intervening beyond pregnancy

As of 2019, around 7% of all children in England were exposed to tobacco smoke in the home, increasing

their risk of sudden infant death (SIDS), chest infections, asthma and meningitis, and making them 90% more

likely to start smoking themselves.23 24 25 There is also emerging evidence of an association between home

smoking restrictions and reduced adolescent smoking behaviours.26

Evidence suggests that becoming a father is a significant transition period which provides a window of

opportunity to engage and support fathers in quitting smoking or creating a smokefree home.27 28 29 As adults

become parents, the decision to reduce or quit smoking becomes more prominent, influenced by:

» The de‐normalisation of tobacco use during pregnancy for women, and;

» The negative effects of SHS on children.27

Smoking is increasingly incongruent with fathers’ views of themselves as a role model and protector to their

children, with reducing and quitting smoking constructed as part of the process of engaging in fatherhood.27

There are challenges in effectively engaging fathers with stop smoking interventions. A study of new fathers’

narratives around reducing and quitting smoking, found that fathers are reluctant to rely on stop smoking aids

and medications; instead self‐reliance, willpower, and autonomy figured more prominently in their

narratives.27 Another study found that many men were more likely to deny or conceal their smoking rather

than seek support to quit, and found that online stop smoking materials which provide anonymity and are

tailored to men’s experiences could be an effective method for engaging smoking fathers.30

6.1 Gender appropriate approaches: reaching new fathers

FACET (Families Controlling and Eliminating Tobacco), based at the University of British Columbia in

Canada, is engaged in several programmes to find original ways to support young families in their efforts to

become smokefree, including work to help new fathers quit smoking.31

Booklet: The right time… The right reasons… Dads talk about reducing and quitting smoking (2010)

FACET’s ‘The right time… The right reasons…’ booklet is based on fathers’ experiences of reducing and

quitting smoking and is designed to provide fathers who smoke with information and advice to encourage

quitting.32 It includes quotes from expectant/new fathers who smoke or have successfully reduced/quit

smoking, advice about the best ways to quit, and a Q&A which highlights facts about the harms of SHS and

the benefits of quitting. The booklet presents becoming a father as a key opportunity to quit smoking and

emphasises the positive impact on the child/family, in terms of improved health and improved household

finances. The booklet portrays the decision to quit/cut down as a way of being a responsible father who

provides for his family.32

“I actually have a kid now and my smoking is not just about me anymore. My smoking also makes it harder

for my partner to quit.”

“Taking my smoking outside helps my baby stay healthy. But I keep thinking about what I’m missing when

I’m outside smoking. The guys at work understand that I want to be a good example for my child.”

8

The ‘Dads in Gear’ (DIG) programme 28 33

FACET has also trialled a ‘Dads in Gear’ (DIG) 8-week, gender-sensitized smoking cessation programme

targeting fathers. The DIG programme design is based on three integrated components: smoking cessation,

physical activity and fathering.

The programme was delivered in 5 community sites by trained male facilitators to fathers who smoked and

wanted to quit. The programme consisted of weekly 2-hour face-to-face group sessions which focused on

increasing men's cessation self-efficacy and providing peer and facilitator support. Materials to support the

delivery of the programme, recruitment of participants, and facilitator training were provided via the DIG

website.34

21 fathers completed the programme, with 35.5% of participants being abstinent (self-reported) at 3-month

follow up.33

See the FACET website for more information: http://facet.ubc.ca/

6.2 Lessons for practice

» Becoming a father is a significant transition period which provides a window of opportunity to engage

and support fathers in quitting smoking or creating a smokefree home.

» Evidence suggests that smoking is inextricably linked to the social relationships and environments in

which it occurs.22 Positive social support from peer groups may be effective for helping fathers quit

smoking i.e. messages from Dads may be more effective with Dads.

» Peer to peer approaches which focus on increasing men's cessation self-efficacy should be explored

further.

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7. Creating smokefree homes

There are currently too few published studies assessing smokefree home interventions with fathers to draw

conclusions regarding effective approaches. However, several interventions have been trialled which merit

further exploration.

7.1 Using air quality measures to engage parents

There is some evidence to suggest that approaches which utilise feedback on air quality measures may be

effective for engaging parents around household smoking, although further work is required to identify the

best approach for engaging more deprived households.35 36 37 8

Under the AFRESH programme researchers have specifically developed interventions aimed at supporting

disadvantaged households.38 This intervention consists of 6 modules, each module addressing a particular

aspect of behaviour change, and is designed to be delivered face-to-face by healthcare professionals to

parents and other household members who smoke. It includes up to five meetings with parents, two sets of

five days’ air quality monitoring for concentrations of PM2.5 – fine particulate matter found in tobacco smoke

– with personalised feedback, and the option to involve other household members in creating a smokefree

home using educational, motivational, and goal setting techniques. This intervention is based on the current

evidence around smokefree homes interventions, including the REFRESH (reducing families' exposure to

secondhand smoke in the home) intervention.35 37 38 A small-scale pilot of AFRESH found that the intervention

was acceptable for the target population and may help participants to create smokefree homes, however the

resources required for the delivery of AFRESH do not match with the resources typically available in third-

sector organisations.39

The ‘First Steps 2 Smoke-free’ intervention trialled the use of air quality feedback with new mothers living in

deprived households, using an approach delivered as part of health professionals’ routine work.40 Women

reported that the intervention had increased their awareness of SHS risks to their children, and their

motivation to change home-smoking behaviours. However, the intervention was ineffective at creating actual

change, as attempts to create a smokefree home were often constrained by lack of access to suitable, safe

outdoor space; the challenges associated with looking after young, mobile children; and others’ smoking in

the home.40 Using NRT or an e-cigarette for temporary abstinence in the home could address some of these

complexities, alongside the development of smokefree home interventions that work with men and other

family members, framing household smoking as a collective responsibility.40

A 12-week smokefree homes intervention with primary caregivers of children aged under 5 years, who

reported smoking in the home and were not motivated to quit found feedback on air quality could motivate

quitting behaviours.41 The intervention comprised of feedback on the air quality measured in the home

(PM2.5); behavioural support on how to create a smokefree home; and provision of NRT for temporary

abstinence or for cutting down tobacco smoking. The intervention successfully reduced children’s exposure

to SHS in the home, resulting in improved home air quality, lower child salivary cotinine, lower cigarette

consumption in the home and increased likelihood of having made a quit attempt, compared to ‘usual care’.

Although the intervention did not specifically target smoking partners, this approach could be tailored for the

whole household.41

Feedback on air quality (PM2.5) in the home may be effective for engaging those who smoke inside the home.

However, the evidence to date suggests that air quality feedback and VBA have not been sufficient to change

household smoking behaviour in more deprived households.37 Personalised feedback may be more effective

if combined with behavioural support and perhaps with the additional provision of NRT or e-cigarettes.38 41

7.2 Considering cultural contexts

A review of fathers’ views and experiences of creating a smokefree home found that attitudes and knowledge,

along with cultural and gender norms play a significant role in shaping fathers’ beliefs and knowledge

regarding the health risks of SHS exposure to children and the importance associated with creating a

smokefree home.9 The review primarily focused on Asian countries where smoking is not the cultural norm

for women, and children are largely exposed to SHS through the father. In this context, there is some

evidence that community-wide interventions which aim to change smoking norms could be effective, although

further research is needed.42 43 The authors concede that different approaches may be required in countries

10

with greater emphasis on gender equality compared to Asian countries – Western European countries for

example – to support fathers to effectively create and maintain a smokefree home.9 These findings could be

useful for informing smokefree homes interventions in minority ethnic communities with high rates of paternal

smoking.

Case study 3: Dorset HealthCare University NHS Foundation Trust and Public Health Dorset:

Exploring the use of CO screening by health visitors to support smoking cessation in

pregnancy and the postpartum period

Strategic aim

Health visitors in Dorset are piloting a new project to engage with families around the harms of CO (carbon monoxide) and smoking with the aim of reducing the prevalence of smoking households.

Design

The health visitors received a three-hour training session on delivering a smoking cessation brief intervention and using a CO monitor.

When visiting a household, the health visitor offers all members of the household a personal exhaled breath CO test. Offering CO testing as part of the routine pathway enabled the conversation about smoking behaviours to be more meaningful and helps to facilitate a conversation about SHS and the risk to the baby and others in the household.

Following the CO test, household members with elevated CO levels (4ppm and above) receive Very Brief Advice (VBA) and are offered a referral to the local stop smoking service. Those declining support or indicating that they do not wish to quit, will be informed of the benefits of switching to vaping in line with the advice from Public Health England.44

Health visitors reported that they wanted further training to cover cessation methods and e-cigarettes to support those who did not want to be referred to smoking cessation services.

Initial outcomes

Results from the early stages of the pilot found that almost half (48%) of the 33 participants managed to quit smoking during pregnancy. Of these, 69% remained smokefree up to 6-8 weeks postpartum. Health visitors reported they were able to help have more meaningful conversations with mothers and their partners using the CO monitor as an engagement tool. Those partners present during the visit were also screened for CO.

7.3 Lessons for practice

» Interventions which combine personalised feedback on home air quality with behavioural and

pharmacological support could help new parents keep a smokefree home.

» Feedback on home air quality can be an effective way to engage women and partners around smoking

cessation.

» Evidence suggests that parents living in disadvantaged households require a tailored approach that

not only acknowledges the limited opportunities that they have to take their smoking outside, but

provides a practical means to overcome these limitations (e.g. NRT).

» Carbon monoxide (CO) testing can be an effective tool for engaging and motivating smoking partners.

» Ethnic groups with low rates of maternal smoking where children are largely exposed to SHS through

the father may require tailored interventions which take into account cultural and gender norms.

11

8. Conclusions

» Population level interventions to reduce smoking prevalence among young men and women from

more deprived groups are likely to be effective for reducing rates smoking and exposure to SHS during

pregnancy.

» Interventions to reduce partner smoking at preconception are currently lacking and should be

developed.

» Current evidence suggests that encouraging women to change their partner’s behaviour is not an

effective approach to reduce exposure to SHS in the home.

» Interventions which encourage men to take responsibility for their smoking behaviour appear to be

more effective, particularly when delivered at the household level.

» Significant others need to be involved not just as providers of social support but as participants with

a stake in the change process.

» Interventions which offer partners pharmacotherapy and financial incentives can be effective for

increasing quit rates among pregnant women and partners, although further research is needed.

» Carbon monoxide (CO) testing can be an effective tool for engaging and motivating smoking partners.

» Peer-to-peer approaches which focus on increasing men's cessation self-efficacy as used by FACET

in Canada should be explored further.

» There is some evidence that interventions which combine personalised feedback on home air quality

with behavioural and pharmacological support could help new parents keep a smokefree home.

» Ethnic groups with low rates of maternal smoking where children are largely exposed to SHS through

the father may require tailored interventions which take into account cultural and gender norms.

» Parents living in disadvantaged households require a tailored approach that not only acknowledges

the limited opportunities that they have to take their smoking outside, but provides a practical means

to overcome these limitations.

» There is a lack of agreement within published research on how best to assess non-smoking pregnant

women’s exposure to SHS, both pre- and post-intervention. Objective measures such as salivary

cotinine or hair nicotine are expensive and time consuming whereas self-report measures of SHS

exposure or partner smoking are inherently unreliable.

» The quality of future interventions would be improved by validated questionnaire tools and a

standardised measure to assess pre- and post-intervention exposure to SHS.

» There is a need to build the evidence base and identify an effective intervention which can be

replicated at a population level. The case studies included in this briefing should inform the design of

future interventions to reduce partner smoking.

12

References

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